Bhaveen H. Kapadia

Periprosthetic joint infection

Periprosthetic joint infections are a devastating complication after arthroplasty and are associated with substantial patient morbidity. More than 25% of revisions are attributed to these infections, which are expected to increase. The increased prevalence of obesity, diabetes, and other comorbidities are some of the reasons for this increase. Recognition of the challenge of surgical site infections in general, and periprosthetic joint infections particularly, has prompted implementation of enhanced prevention measures preoperatively (glycaemic control, skin decontamination, decolonisation, etc), intraoperatively (ultraclean operative environment, blood conservation, etc), and postoperatively (refined anticoagulation, improved wound dressings, etc). Additionally, indications for surgical management have been refined. In this Review, we assess risk factors, preventive measures, diagnoses, clinical features, and treatment options for prosthetic joint infection. An international consensus meeting about such infections identified the best practices and further research needs. Orthopaedics could benefit from enhanced preventive, diagnostic, and treatment methods.

The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center.

The purpose of this study was to measure the impact of periprosthetic joint infections (PJIs) on the length of hospitalization, readmissions, and the associated costs. Between 2007 and 2011, our prospectively collected infection database was reviewed to identify PJIs that occurred following primary total knee arthroplasty (TKA), which required a two-stage revision. We identified 21 consecutive patients and matched them to 21 non-infected patients who underwent uncomplicated primary TKA. The patients who had PJIs had significantly longer hospitalizations (5.3 vs. 3.0 days), more readmissions (3.6 vs. 0.1), and more clinic visits (6.5 vs. 1.3) when compared to the matched group, respectively. The mean annual cost was significantly higher in the infected cohort (

Increased Revision Rates After Total Knee Arthroplasty in Patients Who Smoke

116,383; range,

Long-Term Implant Survivorship of Cementless Total Knee Arthroplasty: A Systematic Review of the Literature and Meta-Analysis

44,416 to

Mechanical, Anatomical, and Kinematic Axis in TKA: Concepts and Practical Applications

269,914) when compared to the matched group (

Pre-admission Cutaneous Chlorhexidine Preparation Reduces Surgical Site Infections In Total Hip Arthroplasty

28,249; range,

Chlorhexidine Reduces Infections in Knee Arthroplasty

20,454 to

Does obesity affect the outcomes of primary total knee arthroplasty

47,957). Periprosthetic infections following TKA represent a tremendous economic burden for tertiary-care centers and to patients.

Tobacco Use May Be Associated With Increased Revision and Complication Rates Following Total Hip Arthroplasty

The purpose of this study was to compare the clinical outcomes of total knee arthroplasty in patients who reported a history of tobacco use with those who were nonsmokers. Between 2006 and 2009, there were 131 total knee arthroplasties performed in patients who were smokers and 490 in patients who did not smoke. At a mean follow-up of 47 months (range, 24-79 months), the patients who were smokers had a statistically decreased overall survivorship of 90% (13 revisions) compared with 99% (5 revisions) in the nonsmokers. Surgical complication rates were not significantly different between the 2 groups; however, there was a significant difference in medical complications. Total knee arthroplasty in smokers has a higher risk of negative clinical outcomes compared with nonsmokers.

Clinical, Objective, and Functional Outcomes of Manipulation Under Anesthesia to Treat Knee Stiffness Following Total Knee Arthroplasty

Cementless total knee arthroplasty (TKA) has had limited use in the United States, however, recent reports have demonstrated promising results, but there has been no meta-analysis to examine these outcomes in the past 5 years. In this review, 37 studies (2,940 patients and 3,568 TKAs) were identified and used, comparing cementless to cemented TKA. Pooled implant survivorship was compared using a fixed-effect meta-analysis between cementless and cemented TKA, and between cementless TKA with and without screw fixation. Cementless TKA had implant survivorship comparable to cemented TKA (odds ratio, 1.1; 95% confidence interval [CI], 0.62-2.00). The mean survivorship at 10 years for cementless TKA was 95.6% compared with 95.3% for cemented TKA. At 20-year follow-up, implant survivorship decreased to 76 and 71%, respectively. No difference was observed between fixation with or without screws (OR, 1.1; 95% CI, 0.16-7.5). Implant survivorship for cementless TKA was comparable to the current gold standard cemented TKAs.